美托咪啶用于全身麻醉的隨機對照試驗的Meta分析_《中國循證醫學雜志》

作者：

孫捷豪 , 韓寧 ,  吳秀英

中國醫科大學盛京醫院麻醉科（沈陽 110004）;

關鍵詞：

美托咪啶全身麻醉隨機對照試驗 Meta 分析

DOI：

10.7507/1672-2531.20080174

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價美托咪啶用于全身麻醉患者的臨床效果和安全性。
方法　電子檢索PubMed、EBSCO、Springer、Ovid、外文生物醫學期刊全文數據庫和CBMdisc、CNKI，文獻檢索起止時間均從建庫至2008 年4 月，同時檢索納入文獻的參考文獻，納入探討美托咪啶用于全身麻醉患者的臨床效果與安全性的隨機對照試驗，并逐個進行質量評價和資料提取。統計學分析采用RevMan 4.2.10 軟件。
結果　共納入25 個隨機對照試驗（共1 241 例）。Meta 分析結果顯示：與生理鹽水相比，美托咪啶能降低圍手術期患者的心率和血壓，減少術后惡心嘔吐［RR=0.57，95%CI（0.38，0.84）］、躁動［RR=0.29，95%CI（0.17，0.51）］、寒戰［RR=0.45，95%CI（0.29，0.68）］，但增加患者心動過緩［RR=2.16，95%CI（1.58，2.95）］和低血壓［RR=2.97，95%CI（1.42，6.18）］的發生率。加用美托咪啶能減少硫噴妥鈉、異氟醚、芬太尼的用量，而在減少肌松藥的用量方面與生理鹽水相比，兩者差異無統計學意義。美托咪啶在早期蘇醒指標上與生理鹽水組無差異，由于術后并發癥較少，美托咪啶組患者能更快地出蘇醒室［WMD=15.17，95%CI（3.87，26.46）］。
結論　現有有限資料表明，在維持圍手術期血流動力學平衡上，美托咪啶優于生理鹽水。此外，美托咪啶還能減少術后惡心嘔吐、躁動、寒戰的發生；減少靜脈和吸入麻醉藥的用量，但不減少肌松藥的用量；在蘇醒時間上，美托咪啶與生理鹽水組無差異，在出蘇醒室時間上，美托咪啶更有優勢。

引用本文： 孫捷豪,韓寧,吳秀英. 美托咪啶用于全身麻醉的隨機對照試驗的Meta分析. 中國循證醫學雜志, 2008, 08(9): 773-780. doi: 10.7507/1672-2531.20080174 復制

1.	Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71(1): 108-118.
2.	Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54(2): 146-165.
3.	李慧玲, 佘守章, 莫世湟, 等. 右旋美托咪陡對全麻患者腦電雙頻譜指數及靶控輸注異丙酚用量的影響. 廣東醫學, 2004, 25(12):1394-1396.
4.	Gurbet A, Basagan-Mogol E, Turker G, et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth, 2006, 53(7): 646-652.
5.	Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6.	Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and perioperative haemodynamic stability. Anaesthesia, 1997, 52(8): 736-744.
7.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
8.	Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol, 2005, 22(5): 386-391.
9.	Jaakola ML, Al i-Melkkil? T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth,1992, 68(6): 570-575.
10.	Jaionen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting. Anesthesiology, 1997, 86(2): 331-345.
11.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
12.	Yildiz M, Tavlan A, Tuncer S, et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D, 2006, 7(1): 43-52.
13.	Durmus M, But AK, Dogan Z, et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol, 2007, 24(5): 447-453.
14.	Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg, 2000, 90(4): 834-839.
15.	Tanskanen PE, Kytt JV, Randell TT, et al. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth, 2006, 97(5): 658-665.
16.	Ozkose Z, Demir FS, Pampal K, et al. Hemodynamic and anesthetic advantages of dexmedetomidine, an alpha 2-agonist, for surgery in prone position. Tohoku J Exp Med, 2006, 210(2): 153-160.
17.	But AK, Ozgul U, Erdil F, et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand, 2006, 50(10): 1207-1212.
18.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8): 1088-1091.
19.	Taittonen MT, Kirvel OA, Aantaa R, et al. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth, 1997, 78(4): 400-406.
20.	Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg, 1992, 75(6): 932-939.
21.	Aantaa R, Jaakola ML, Kallio A, et al. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology, 1997, 86(5): 1055-1060.
22.	Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol, 2006, 23(2): 149-153.
23.	Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg, 2006, 103(1): 52-56.
24.	Aho M, Erkola O, Kallio A, et al. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominalhysterectomy. Anesth Analg, 1992, 75(6): 940-946.
25.	Aho M, Lehtinen AM, Erkola O, et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology, 1991, 74(6): 997-1002.
26.	Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology, 1995, 82(3): 620-633.
27.	吳新民, 許幸, 王俊科, 等. 靜脈注射右美托咪陡輔助全身麻醉的有效性和安全性. 中華麻醉學雜志, 2007, 27(9): 773-776.
28.	Ebert T, Hall JE, Barney JA, et al. The effects of increase plasma concentration of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
29.	Bakhamees HS, El-Halafawy YM, El-Kerdawy HM, et al. Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anesthesiol, 2007, 19(3): 537-551.
30.	Del A, Castellanos O, Munguia M. Dexmedetomidine as preventive postoperative analgesia in inguinal hernioplasty. Gac Med Mex, 2006, 142(1): 9-12.

1. Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71(1): 108-118.
2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54(2): 146-165.
3. 李慧玲, 佘守章, 莫世湟, 等. 右旋美托咪陡對全麻患者腦電雙頻譜指數及靶控輸注異丙酚用量的影響. 廣東醫學, 2004, 25(12):1394-1396.
4. Gurbet A, Basagan-Mogol E, Turker G, et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth, 2006, 53(7): 646-652.
5. Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and perioperative haemodynamic stability. Anaesthesia, 1997, 52(8): 736-744.
7. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
8. Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol, 2005, 22(5): 386-391.
9. Jaakola ML, Al i-Melkkil? T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth,1992, 68(6): 570-575.
10. Jaionen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting. Anesthesiology, 1997, 86(2): 331-345.
11. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
12. Yildiz M, Tavlan A, Tuncer S, et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D, 2006, 7(1): 43-52.
13. Durmus M, But AK, Dogan Z, et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol, 2007, 24(5): 447-453.
14. Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg, 2000, 90(4): 834-839.
15. Tanskanen PE, Kytt JV, Randell TT, et al. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth, 2006, 97(5): 658-665.
16. Ozkose Z, Demir FS, Pampal K, et al. Hemodynamic and anesthetic advantages of dexmedetomidine, an alpha 2-agonist, for surgery in prone position. Tohoku J Exp Med, 2006, 210(2): 153-160.
17. But AK, Ozgul U, Erdil F, et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand, 2006, 50(10): 1207-1212.
18. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8): 1088-1091.
19. Taittonen MT, Kirvel OA, Aantaa R, et al. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth, 1997, 78(4): 400-406.
20. Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg, 1992, 75(6): 932-939.
21. Aantaa R, Jaakola ML, Kallio A, et al. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology, 1997, 86(5): 1055-1060.
22. Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol, 2006, 23(2): 149-153.
23. Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg, 2006, 103(1): 52-56.
24. Aho M, Erkola O, Kallio A, et al. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominalhysterectomy. Anesth Analg, 1992, 75(6): 940-946.
25. Aho M, Lehtinen AM, Erkola O, et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology, 1991, 74(6): 997-1002.
26. Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology, 1995, 82(3): 620-633.
27. 吳新民, 許幸, 王俊科, 等. 靜脈注射右美托咪陡輔助全身麻醉的有效性和安全性. 中華麻醉學雜志, 2007, 27(9): 773-776.
28. Ebert T, Hall JE, Barney JA, et al. The effects of increase plasma concentration of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
29. Bakhamees HS, El-Halafawy YM, El-Kerdawy HM, et al. Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anesthesiol, 2007, 19(3): 537-551.
30. Del A, Castellanos O, Munguia M. Dexmedetomidine as preventive postoperative analgesia in inguinal hernioplasty. Gac Med Mex, 2006, 142(1): 9-12.

《中國循證醫學雜志》

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《中國循證醫學雜志》

美托咪啶用于全身麻醉的隨機對照試驗的Meta分析

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